Complementary cancer treatment; defusing tense situations; 'recharging' at work: Upstate Medical University's HealthLink on Air for Sunday, Dec. 1, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," learn who uses complementary therapies during and after cancer treatment.

Jamie Romeiser, PhD: ... There's a growing interest not only in people with cancer, but also among providers in exploring non-pharmaceutical options to manage these lingering symptoms or increase the quality of life. ...

Host Amber Smith: Hear from a police chief about de-escalation techniques when tempers flare.

Chief Erika Taylor: ... One thing that I train my team on is finding your pause button. That's definitely easier said than done. Learning to take that deep breath, taking a couple of seconds or minutes, if you will, before you react. ...

Host Amber Smith: And visit a recharge room for when health care work becomes extra stressful.

Leslie Kohman, MD: ... This concept has been used in architecture as far back as the Hanging Gardens of Babylon. ...

Host Amber Smith: All that, along with a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, the chief of university police teaches strategies for deescalating tense situations. Then we'll visit a new recharge room for health care workers and students who need a quick break. But first, which complimentary therapies are popular during and after cancer treatment?

From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air."

How often are people with cancer turning to complementary health approaches during and after their treatment? A team of researchers at Upstate has published a paper on this topic in the Journal of Cancer Survivorship, and I'm speaking with two of the authors. Dr. Kaushal Nanavati is the director of integrative medicine, and Jamie Romeiser is an assistant professor of public health and preventive medicine at Upstate.

Welcome back to "HealthLink on Air," both of you.

Jamie Romeiser, PhD: Thank you so much for having us.

Kaushal Nanavati, MD: Thank you.

Host Amber Smith: Now, what made you want to explore this question, about the prevalence of the use of complementary health approaches?

Jamie Romeiser, PhD: Well, the number of cancer survivors in the U.S. is steadily growing, and cancer survivorship really has quadrupled in over the past 40 years. This rise is largely due to advances in early detection through screening programs, as well as significant improvements in how we treat cancer. So this is really encouraging, that people are living longer with a diagnosis of cancer.

But increased survivorship also brings a shift in health care needs for cancer survivors. And many cancer survivors report lower quality of life during and after treatment, and they face ongoing physical, mental and emotional challenges. And these could include depression, pain, fatigue, stress, anxiety, all of which can persist long after the completion of cancer treatment. So as a result, it's the quality of survivorship. And my wonderful colleague will call that "thrive-ership." This is an emerging critical issue in oncology. There's a growing interest not only in people with cancer, but also among providers in exploring non-pharmaceutical options to manage these lingering symptoms or increase the quality of life.

And there's really a growing body of evidence that supports certain complementary health approaches that can be used to help address these issues in cancer survivors. And this moves more towards that patient-centered approach to cancer survivorship care in treating the whole person and not just the cancer.

Kaushal Nanavati, MD: I guess some things that I'd like to add -- I think that was beautifully explained -- is just some basic definitions. So what's complementary, right? So there's conventional cancer care that relates to medical oncology, surgical oncology, radiation oncology. And then we have these complementary approaches, which span a spectrum.

And again, there's a difference between alternative and complementary. Alternative is often something that doesn't necessarily have great data or research as an alternate to. Whereas, complementary is in conjunction with, in a complement to conventional care. So, one of the things that we focused on is recognizing that survivorship spans the spectrum from high-risk individuals all the way through end-of-life care, and to understand where a complementary approach is can both empower the patient and the caregiver, to feel a sense of control in their journey, to feel a sense of empowerment, and the ability to navigate in their direction is really important. And I think this data, and just looking at what is done currently, helps us not only as an institution that's a comprehensive cancer center, but even in terms of health care moving forward of what we can do to optimize the quality of life of the people that we serve.

Host Amber Smith: So let me ask you, when we talk about complementary practices or approaches, what are we talking about?

Jamie Romeiser, PhD: So, at least in the data that we examined for this study, there were eight different complementary health approaches that were included in the survey data. Survey responders were asked whether they visited a specialist in the past year for chiropractic care, acupuncture, massage therapy, meditation, guided imagery, yoga, and then also music therapy and art therapy.

Host Amber Smith: And did you have an assumption before you began looking into this?

Jamie Romeiser, PhD:

Sort of. In a way, which also relates to whether or not our results are surprising. We sort of assumed that we were going to be finding certain results in relationships to recency of cancers. But you know, you don't want to take those assumptions into any type of research study. So we really just wanted to explore the data.

Host Amber Smith: Sure. Well, tell me about the data set that you used.

Jamie Romeiser, PhD: Sure. We used data from the National Health Interview Survey, which is a survey that's conducted by the National Center for Health Statistics. And it's done on a yearly basis.

Host Amber Smith: How many people were included in the set that you were analyzing?

Jamie Romeiser, PhD: In the data that we analyzed, there was over 26,000 people. And the nice thing about that survey data is that it's nationally representative, which means that the NCHS goes to these great lengths to ensure that people who are surveyed every year represent the U.S. population as a whole.

Host Amber Smith: Did it tell you what years you were looking at?

Jamie Romeiser, PhD: Yeah. So we looked at the most recent data available at the time of our analysis, which was collected throughout 2022.

Host Amber Smith: Well, I'm curious about the results. And I know that you divided it between recent, non-recent and then no cancer. Why was it divided that way?

Jamie Romeiser, PhD: We wanted to understand potential differences in complementary health approaches at various stages of cancer survivorship, so looking at acute versus longer term survivorship. Those with a more recent diagnosis are in that more acute survivorship stage, where there's a focus on fighting the disease, managing side effects and physical and emotional challenges. And those who have been cancer free for a few years might be more focused on maintaining overall health, but there also might be late effects of cancer treatment and remaining physical and emotional needs.

So we looked at the differences in using these complementary health approaches between recent and longer-term survivors, and then we also compared that to people who have never been diagnosed with cancer. And we did find a couple important findings when we examined the data this way. So we adjusted for a number of different characteristics like age, sex, education, income. And we did find that longer-term survivors were about 20% more likely to use complementary health approaches in the past year compared to those without a history of cancer. And then that relationship was even stronger for recent cancer survivors who were 40% more likely to have used complementary health approaches in the past year, compared to people who were never diagnosed.

So when we also broke that down into larger umbrella categories of manipulative therapies and mind-based therapies, this relationship persisted too. We saw the same thing, and it was significant, and of significant magnitude. So recent survivors are more likely to use mind-body and manipulative therapies followed by long-term survivors, followed by people without a history of cancer.

Kaushal Nanavati, MD: Which kind of makes sense, right? Because when you think about somebody who's been diagnosed recently, there's a lot of potential stress, a lot of emotions that come up. And so mind-body therapies are quite beneficial in this realm.

The fact that in the general population, nearly 40-plus percent of people use some type of complementary approach in their care, to see a 1.2 x and a 1.4 x jump for people who have been diagnosed with cancer tells you nearly 50% or more of patients are seeking something that's complementary to the conventional treatment and care to help support them in their journey.

And I think this is fascinating information. Is it surprising? Not so much surprising as it is valuable in how we create programs that support the community and improve access.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Kaushal Nanavati, the director of integrative medicine, and Jamie Romeiser, an assistant professor of public health and preventive medicine at Upstate.

So it seems like certain segments really like having the complementary therapy, whether they're using it for mind-body, or manipulative or complementary approaches of other sorts. But you're not saying that it extends their life -- or are you?

Jamie Romeiser, PhD: No. Well, so you can use these treatments for certain things, right? So these are not going to cure cancer. That's not something that is the function of these types of complementary health approaches. But they can be incredibly useful for, to enhance your health and well-being.

Kaushal Nanavati, MD: We have this institute at our health system, the Nappi Wellness Institute. And at one point we were talking about having the word "longevity" and the idea of redefining longevity as the life in your years versus the years in your life. Some of these complementary approaches help to enhance the quality of the living experience, and that actually, I don't know how you would value that in terms of being priceless in the journey of life because frankly, diagnosis or not, none of us are guaranteed tomorrow. That's just a fact.

And if we live by statistics, then we feel that at least this data helps to support the potential for an improved quality of life. Duration is something that has multiple factors, even beyond what was studied here or what's even done with conventional care, because there are socioeconomic factors, other determinants of health that can impact that specific statistic.

Host Amber Smith: What did the cancer survivors say that they used mind-body approaches for?

Jamie Romeiser, PhD: So the mind-body approaches were mostly used for overall general health, restorative general health purposes, with some pain management.

Host Amber Smith: So we're talking about yoga?

Jamie Romeiser, PhD: Yeah. So we included in the mind-body general category, this is yoga, guided imagery and meditation.

Host Amber Smith: And then I know there's manipulative approaches. Is that chiropractic?

Jamie Romeiser, PhD: Yes. In our data, this included chiropractics, massage therapy and acupuncture. And these are manipulative therapies, more used for physical pain management and manipulation of the body.

Host Amber Smith: And then what other complementary approaches were included?

Jamie Romeiser, PhD: This was actually exciting for me. This was one of the reasons why I looked into this data in the first place, was creative therapies. So the use of music therapy and art therapy. These are therapies that include the arts in a therapeutic way. Unfortunately, use was really low, I guess, in this survey. It might truly reflect the population. But it was actually exciting to see that it was included for the first time with this survey.

Host Amber Smith: Well, let's talk about the conclusion. What did you find?

Jamie Romeiser, PhD: The first thing that I guess I'll talk about is, we did find those utilization patterns more in recent, versus non-recent, versus no cancer. But one of the things that kept coming up, no matter how we looked at this data, whether it was in the whole sample, whether it was just among all cancer survivors, just amongst recent survivors or longer term, is that you also have these other factors that are predicting use. And these factors are women.

Women are more likely to utilize complementary health approaches, but also people who have higher education, higher income and people who are younger. So these relationships are really persisting, no matter how we look at this data. And unfortunately this has been something that I don't think has changed in the last 20 years that we've, researchers, have really been looking at this question. This really indicates a potential sustained socioeconomic barrier and, maybe, an information barrier to using complementary health approaches.

Kaushal Nanavati, MD: I think one of the other things that's important, well, a couple of other things. You know, one is coverage, right? So with a lot of complementary health approaches, people are paying out of pocket to be able to access them. Health systems, comprehensive cancer centers, are starting to incorporate some more of these. But then there's access to information, and then really getting it out into the community.

And so I can say one of the things that we've done with our survivorship program is really re-engaging the primary care team because patients come from a broad region, and for them to be expected to come to one central hub to only be able to access a lot of this information and these services isn't practical. So what we've started to do is, get patients, once they're done with their active treatment, to get them back into their primary care team with the primary care team being informed of many of these resources that are available both online and in the community as well.

And so we've done programs such as what they call ECHO (Extension for Community Health Care Outreach) programs, that engage the community providers to help them understand resources that are available. And as we expand the offerings we have, even through web access and linking everything from yoga sessions, to mindfulness sessions on our website, that creates an opportunity for people who are in a broader region to be able to access this.

And I think that's the big thing, is we know that in general, women tend to access the health care system more. They tend to be the primary decision makers for health in households up to nearly 70% or more depending on the data you look at. And then the other stuff isn't surprising. Higher education, higher income and younger generations. And those things are fascinating because when we understand people in the context of their circumstance, whether it be generational, socioeconomic, then we get a sense of their motivation, their drivers and their barriers. And I think data like this helps us to bring clarity to that, which then allows us to create systems that can overcome those barriers.

Host Amber Smith: So you've got to make people aware of these things that are available and convince them that they might benefit from them. Is that right?

Kaushal Nanavati, MD: Absolutely. The three words available, affordable and then affable. And even though they can't see our smiles right now, you know, we're definitely affable. We're trying to be more available. And then affordability is a system-wide issue that everyone is trying to work on making access that much easier for people.

Host Amber Smith: For someone who maybe is just wrapping up cancer treatment, what would you say to them about what they could expect to get out of a yoga class or an art therapy session?

Kaushal Nanavati, MD: I would say -- and then Jamie, you can definitely share some of your thoughts on this as well -- from my perspective, any treatment, if you think about it, what is the goal? What is our purpose, right?

So conventional thinking is the curative thinking, which is curing the cancer.

Integrative thinking is about healing the person, which has to do with helping them to embrace the stage of life, helping them to optimize their presence in their stage of life, and to be able to create joyful moments, to be able to create happiness and to recognize that contentment and peace are dynamic in our life's journey. And so at different stages they mean different things.

A lot of complementary approaches help people to kind of redefine their journey moving forward, and our goal is to help them recognize what contentment and peace might look like in the context of their individual life and their relationships within their community and with their place within the world as a whole.

Jamie Romeiser, PhD: I think that was really beautifully said. I don't have too much to add to that, but just recognition that there are options for people if they are struggling with different symptoms.

Host Amber Smith: Well, that's good to know. And it's very good information, and I appreciate both of you making time to tell us about it.

Jamie Romeiser, PhD: Thank you so much for having us.

Kaushal Nanavati, MD: Thank you.

Host Amber Smith: My guests have been Jamie Romeiser, an assistant professor of public health and preventive medicine at Upstate, and Dr. Kaushal Nanavati, the director of integrative medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

You have a pause button for when things get tense -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

University Police officers are trained in de-escalation, and I thought it would be useful to hear about some of these techniques because it might help regular people who feel themselves starting to lose their temper in stressful situations.

My guest is Erika Taylor, the chief of University Police at Upstate, who has experienced teaching de-escalation techniques. Welcome to "HealthLink on Air," Chief Taylor.

Chief Erika Taylor: Good morning.

Host Amber Smith: Upstate leaders launched a "Respect and Heal" campaign a year or so ago with many components for reducing violence in health care settings. Your focus on de-escalation ties into that. And even though I know your training is designed for health care staff, I thought people who may be patients or family members of patients might benefit from learning about this. But before we get into details, why do you think there is an issue with workplace violence in hospitals and health care settings?

Chief Erika Taylor: Unfortunately, I think we live in a different world than we did even five or 10 years ago. All of us just went through a pandemic where our worlds drastically changed. We started to face and focus on things that we never really had an opportunity to before. We lost the ability, if you will, to function in a public setting like we did previously. I think a lot of people had a lack of personal interaction with others, a lack of conflict resolution, a lack of the need for critical thinking. And I think as a result of that, we've now seen an increase in these issues nationwide in health care and out of health care.

Host Amber Smith: So this is kind of side effects from the pandemic that we're still dealing with, it sounds like.

Chief Erika Taylor: Yeah, absolutely.

Host Amber Smith: Well, it can be especially stressful, though, when a loved one is ill or injured -- something unexpected, something may be life threatening. Do you have advice for people to help them avoid overreacting?

Chief Erika Taylor: I do. One thing that I train my team on is finding your pause button, if you will. That's definitely easier said than done. Learning to take that deep breath, taking a couple of seconds or minutes, if you will, before you react, before you answer, to think of the questions that you need answers to.

Sometimes it's really important to write things down to take notes or to gather your thoughts later on, in preparation of that next encounter that you may have with medical staff members. And it's really the power of, I think, knowledge and understanding. Oftentimes I think we have people in our facilities that, they may not come from a health care background, or they may not have familiarity with these types of conflict or crises. And it's really challenging to navigate, especially when you may not get the news or the answers that you were anticipating. You may be encountering something that is with your loved one, especially when it comes to children. We love hard, and we fight hard. I think that's a natural instinct, right? So I think it's really important to make sure that we can find our pause with that.

The other side of that, I think, is finding grace. I teach my people about grace all the time, and trying to understand that we come from different backgrounds. We may deal with things differently. Bedside manner is huge, right? So it's really important to take our time as we navigate these crises to have the best result.

Host Amber Smith: I love the concept of finding the pause button. That's something to think about. Now what about nonverbal communication? Why is that part of this?

Chief Erika Taylor: Nonverbal communication is huge. I think it's something that people may not think about, right? But I use the example from COVID, of what did COVID give all of us? Whether you came from a small family or a large family, it gave you a 6-foot rule, right? And it's something that we may not have had before that.

Nonverbal communication is something that doesn't lie, if you will. Your eyes don't lie. Even though we wore masks, I think everyone could always tell what I was thinking, going through my mind. Nonverbal communication is important for de-escalation because it also gives you cues or indicators of how someone may be responding to the message that you're conveying. It may give information or cues on how they may react.

We talk about signs of balling their fists or clapping their hands or throwing an item, slapping their fists on the table, pacing back and forth. You have indicators of anxiety, which is a natural response to crisis, and it also gives you indicators if this may escalate beyond that, if you have someone that may be, they may become violent, or they may become combative, they may become aggressive, verbally or physically.

Nonverbal communication is really important to help you understand and recognize those cues before that actually escalates to that point, and it may provide an opportunity to prevent it from getting that far.

Host Amber Smith: So it doesn't sound like it's something that a person can necessarily control. I mean, it's nonverbal. Their eyes are going to be what they are, and you can read a person's face sometimes.

Chief Erika Taylor: Mm-Hmm.

Host Amber Smith: But maybe they would notice that in their companion or their friend that's with them.

Chief Erika Taylor: Yes, absolutely. I think you may know those that are closest to you, with their verbal cues are more than anyone else.

Especially with my own team, I tell the supervisors: Know your people. You should know if they look a certain way, or they're acting a certain way, or they're responding in a certain way, that that may be their normal, or it may not be. It also helps us regulate our teams a little bit better. And recognizing those cues in your own people helps you recognize those cues with individuals you are not familiar with.

I think as a person. Initially, you may not be able to control that, but I do think self-reflection is also really important. If we recognize that maybe we wear our heart on our sleeve, if you will, or that we may have a nonverbal cue that may be a trigger for others, it may escalate others, I think it's really important, I think, to recognize those in ourselves, so we also are better at responding to crisis.

It's very important that crisis is a two-way street. It's a two-way communication. So those individuals delivering the message, that may be the trigger. We may be part of escalating that beyond what it could have been, and vice versa. So I do think that self-reflection is still just as important.

Host Amber Smith: Now are we still keeping the 6 feet of personal space?

Chief Erika Taylor: So some people do. I grew up in not a huge family, but I don't think I really ever had that 6-foot rule. And now I even find myself liking my distance, if you will. So I don't know as if we're really keeping it by rule, but I do think that people may be aware of their surroundings a little bit more of who's in their space. And I also find that it's helping with deescalation because if we can respect that space, in my world, it's what I call a "reactionary gap." And what it really means is it just gives people kind of that opportunity to gauge their surroundings, to recognize the crisis or the trauma that they're in and navigating that appropriately.

I think when we close the gap on people, and we encroach on their space, we automatically are making them more anxious. It's just natural.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host Amber Smith. I'm talking with Chief Erika Taylor. She leads the University Police Department at Upstate, and we're talking about de-escalation techniques

Now what is empathetic listening, and is this something people can practice with their health care providers?

Chief Erika Taylor: Absolutely. So empathy is something where you really listen to understand. You listen to hear what the message is. You're not just listening to check that box that you've heard a conversation. Empathy is really important because if someone doesn't feel that you care, then you may have completely lost that relationship. I compare empathy to customer service, if you will, that the population that you're serving or the population that you're encountering really needs to think that you are tuned into their message.

We may think of encounters where we've had a medical staff member come into a room on a computer on wheels, or I'm going to age myself here, but on a BlackBerry, right? They're doing things on their phone. And the patient or the family member that they're dealing with may not think that they have their undivided attention. So if you don't have their undivided attention, they're not going to think that you care. And in fact, they're not going to think that you have empathy. So I would relate the two of them together. But I do think it's definitely an active listening process that people should practice, because also if you're listening to hear and you're listening to understand, you may be able to focus on the facts versus the feelings, or a better balance of.

Host Amber Smith: For a family member who is getting frustrated, they don't feel like their questions are getting answered, do you have suggestions for what they can do?

Chief Erika Taylor: I do. I oftentimes recommend taking a pause, like we had already talked about, to see if we can restart that conversation. Upstate has a term. They call it "U-turning a conversation." In the middle of crisis, if a conversation is not going as we had anticipated, or it's starting to escalate for reasons, we use the term, "let's U-turn this conversation." And really it's a second chance at that conversation to see if you can have a better understanding.

Being excited or emotional throughout the conversation may not lead to such a productive conversation or active listening or understanding and communication, so I also think it's important. Sometimes personalities just don't mesh and I also think that it's completely OK to take a step back and ask if there's someone else that they can speak with.

I also think it's important if we, as the staff member, are finding that maybe we aren't the best fit for that conversation or we aren't connecting with them to find someone on our team that may be able to do that for us. I think humbling ourselves a little bit and realizing it doesn't have to be me. It definitely can be somebody, maybe I have somebody that would connect with them better. So again, finding that pause. I think we often find that escalating beyond that, it doesn't really help the conversation. There's not a lot of conflict resolution, if you will, during those moments. So finding the appropriate people to have that would be important.

Host Amber Smith: Now, do University Police get summoned to intervene if there's a disagreement that's escalating?

Chief Erika Taylor: We do sometimes. So we have well over 100 contract security guards that work for us under University Police. And they're often that first line of defense. They often get called to help with that de-escalation, to help be that buffer. If the conversation is escalating beyond that, or there's a concern for safety, there's a concern that someone may become violent or aggressive, then they would contact University Police to escalate it to that next level.

I say sometimes it's like parking a police car at a stop sign. Sometimes our presence alone is enough to really de-escalate that and get it to stop. Other times it's not. But I would say the majority of the time those efforts are successful in one way, shape or form in reducing the conversation. So we have a chance to U-turn and start over.

Host Amber Smith: So that's when officers would use the de-escalation techniques that you've taught them.

Chief Erika Taylor: So officer presence is actually part of de-escalation. It's really, our continuum kind of starts there. But, yeah, we definitely assist medical staff in that de-escalation process all the time. Sometimes we find their pause for them, and essentially we just get them to stop for a second. We have an opportunity to talk with all the parties that are involved, the medical staff members, the patients, the families, and sometimes we are able to re-convey that message, to have better understanding. And then the situation's over from there. We would use all versions of that to find a solution.

Host Amber Smith: Any advice for people who are headed to the hospital to be with a loved one who's ill or injured? Things to leave at home, things to bring with them?

Chief Erika Taylor: We do have weapons detection systems and screening systems that are coming into our facility, so definitely no weapons of any kind. One thing to know about SUNY Upstate Medical University is we are, technically, a SUNY school, so handguns, if they are a legal permit-holding individual, they're not allowed to have them here at Upstate.

Otherwise, I would definitely recommend things that they can keep their mind busy with, Sudoku or word puzzles. Bring a phone charger if that's something that you would like to scroll. Think whatever items that you can think of that are going to help keep your mind at ease, that are going to help you de-escalate during crisis.

I was recently at the hospital with my own son, and I know that I'm trained for this, I do this every day. It's different when it's your own loved one. And finding things that are going to keep your stress level low. We all have a natural level of anxiety, which is extremely escalated when we're taking care of those that we love. So I think we need to put our needs kind of in front of that.

So I would recommend any devices that would help distract your mind, but keep you focused, if that makes sense, and help keep you calm. Cellphone chargers are big ones, but definitely busy items, if you will.

Host Amber Smith: Well, that's very good advice. And I thank you so much for making time for this interview.

Chief Erika Taylor: You're very welcome.

Host Amber Smith: My guest has been Chief Erika Taylor from Upstate's University Police Department. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," Upstate offers a place for workers and students to recharge. From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Jobs in health care can be stressful. Now, workers have a new way to recharge before or after work or during a break. I'm talking about the new recharge room with Upstate's chief wellness officer, Dr. Leslie Kohman. Welcome back to "HealthLink on Air," Dr. Kohman.

Leslie Kohman, MD: Thanks, Amber. I'm happy to be here to talk about this.

Host Amber Smith: Well, can you start by describing what this room is like?

Leslie Kohman, MD: Yes. A recharge room is something installed by a wonderful vendor in New York City called Studio Elsewhere, a creative design and neuroscience small company. A recharge room is an immersive, private space that includes music, scent, lighting and sound, designed with research support from the Abilities Research Center at the Mount Sinai School of Medicine in New York, to support the well-being and recovery of care providers. These rooms use a biophilic design concept that aims to connect people to nature through the use of natural elements, space and place conditions.

Biophilic design is actually a concept used in the building industry to increase the connectivity of building occupants to the natural environment. It can use direct nature, indirect nature, such as video or imaging and space and place. This can be on this building-based level or the city scale, and it has health, environmental, and even economic benefits for the building occupants. This concept has been used in architecture as far back as the Hanging Gardens of Babylon.

Host Amber Smith: Interesting. So it sounds like a place where you can take a short escape from the hospital setting.

Leslie Kohman, MD: That's right. It's a voice activated, multi-sensory experience. It's dimly lit and quiet, unless an experience is in progress. There's a pleasant scent that's dispensed automatically. There are candles and plants. One wall is a very large video screen occupying the whole wall, and there are two or three comfortable chairs set up in front of this video wall. There's room for additional people to sit on the floor if they like to do that.

On the wall is a video menu of 10 different nature experiences that people can choose from. Many of them include water. There's a sunrise shores that's the sun rising over a sandy beach. There's rainforest falls that's a beautiful waterfall in a rainforest. There's a misty lake, which is mist rising off a lake at dawn. And several others, up to about 10 of these. Each of these experiences lasts 10 or 15 minutes and is accompanied by specific music, designed by a Studio Elsewhere's creative team to complement the video experience.

And the system is voice activated, so once you sit down, you can look at those pictures and decide which one you want to experience. And the video and audio begin and lasts for somewhere between 10 and 15 minutes. These experiences are changed out by the creative team every six or eight months.

Host Amber Smith: Let's talk about how you decided that a recharge room would be a good addition for the staff and students at Upstate. What sort of research or surveys were done, and what were the results?

Leslie Kohman, MD: During the beginning of the pandemic, as you can remember, there was extreme distress in New York City earlier than everywhere else because they had a large, large number of very critically ill patients pouring into their hospitals.

And the Mount Sinai Hospital said, we have to do something for these overstretched staff. And they put up blow-up tents outside their emergency room where their staff could go to take a break, and they installed a prototype of this recharge room there. And this was actually in The New York Times and other publications, both medical and non-medical.

And we read about it. And of course we have many, many data points that show the increased distress of all of our health care workers during the main part of the pandemic. So we thought this would be a great thing to do. We discovered that this approach was actually supported by scientific research that's been published in the psychological literature, that even a 15-minute experience like this for frontline health care workers led to an average 60% reduction in self-reported stress.

So I was, I proposed this to hospital administration because they were the ones who had to allocate the space and build out the space, which means they had to find a room, and we actually carved this space out of the cafeteria. It had to be built completely to specifications with no windows, and outlets and wiring all in exactly the place that they were recommended by the company. And then in July of this year, workers from Studio Elsewhere actually came here and spent almost a week installing the equipment in the room. And, for the installation we used philanthropic funds from the Upstate Foundation. And we will be installing a second room at our (Upstate) Community Hospital as soon as that room build out is completed.

Host Amber Smith: Now, what are some other things that staff and students have at Upstate to reduce stress?

Leslie Kohman, MD: Well, I just made a comprehensive list of everything under the Upstate "Well" umbrella, and I will tell you that I have had the position of chief wellness officer for four years now, this month, four years. I am the second person that had any kind of official wellness role here, the first being Suzanne Brisk, who started our Pathway to Wellness program 12 years ago. This was under the direction of employee-student health and through HR (human resources,) and it was basically focused on personal resilience and didn't have any institutional improvement components to that program, but it was very valuable for many years. Besides me, we also have Dr. Kaushal Nanavati who is the assistant dean for wellness over in the colleges, who has the wellness of the students and residents at the core of his focus area.

But for all hospital employees, staff, and we include all learners and workers at Upstate, we have a smorgasbord of more than 40 different programs that include community-building groups for having dinner together and meeting new people. We have a trained cadre, more than 30 individuals who've been fully trained in critical incident stress management to help their colleagues when there's a stressful event such as a patient's poor outcome or an interpersonal conflict or whatever it is. We have a team of people on call 24/7 who can go to that unit. And they are trained to provide the support to help the staff through those.

We have a 24-hour nurse triage hotline for our staff. People can call there and get directed to the resource for whatever kind of challenge to their well-being they are experiencing at the time. And we have many personal resilience programs. We have a meditation Tranquility Tuesdays, we have a Monday Mile walking program. We have many New York state wellness activities that our people have access to as well.

We have coaching and leadership training. We have educational seminars and programs. We have department level activities, and we have, currently, about 25 representatives from all different departments who are taking a role in this, in the wellness activities for their own departments. So we have a very large number of things and a very small staff, so as people have ideas, they've been volunteering and working hard to get those ideas to come to pass.

One other one I will mention that people really love is our Pet a Pooch program, where volunteers with their dogs come and spend time in with the staff, and 50 or 60 or even more staff members will stop in during an hour and a half when a dog is there, and you can just watch them calm down as this happens.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Upstate's chief wellness officer, Dr. Leslie Kohman, about recharging to help reduce stress.

Is work in health care inherently going to be stressful?

Leslie Kohman, MD: Well, I think yes. People can absolutely imagine we're dealing with life and death things, and we face people every day for whom the happenings of this day are the most life-changing thing that's ever happened to them. And we experience that through our patients multiple times a day. So there's a huge amount of emotional content to this type of work, as well as risks of bad patient outcomes or severe trauma that comes in through the emergency room. That really does create a lot of stress for the staff. So it's very important to help them, all of us, deal with that because nobody can bear that burden alone. And health care workers, by design, the people who go into health care work are self-effacing, and always want to put the patient first. But that's not always the right thing to do. The airline industry tells us to put our own oxygen mask on first before helping others, and we need to remember that.

Self-compassion is extremely important and also frequently absent in our very dedicated health care workers. And Dr. Robert Corona, our CEO, has a video message every week, and he always ends it with, "be kind to yourself, be kind to others," and you can tell from that statement that you have to start with yourself. If you don't care about yourself, No. 1, who else is going to care about you as much as you? And No. 2, how are you going to care for others if you don't care for yourself? So it's extremely important and not practiced nearly as much by health care workers.

Host Amber Smith: Why do you think that stress-reducing programs like the Recharge Room for workers and students, why do you think those things matter to patients in the long run?

Leslie Kohman, MD: Well, it's absolutely proven in the (scientific) literature that a stressed medical staff and stressed health care workers in general, nurses, doctors, whoever they may be, provide less optimal patient care. Well physicians, well nurses, well staff provides the optimum in patient quality of care. So we should all want our people who take care of us to be feeling very good and practicing self-compassion and wellness techniques because they will give us better care that way. And we definitely want to make sure that all our patients at Upstate are getting the absolutely best quality of care.

Host Amber Smith: In your research, did you find other stress reducing ideas that might work in a health care workplace?

Leslie Kohman, MD: Well, there's a huge literature, or growing, shall I say, literature in things that help. Some of the things that we know about are peer support. So if you are having a bad day or a bad outcome, if you can talk, just even for a few minutes, to another person whose sole job for those few minutes is to listen to you and understand, you'll definitely feel better.

So we have had a strong peer support program in the past, and we are now working on getting 100 people trained in psychological first aid, which is just a one-hour training. But if everybody did that, you could be more compassionate to those around you.

One thing we all need to remember is that you don't have any idea what is going on with your colleague. They may be having a crisis at home. They may have just had a bad patient outcome. They may have any kind of mental, physical, or emotional challenge that they're having this day, and when you relate to them, most of us don't really recognize what's behind somebody else's behavior, and if we learn to do that, everything will be so much smoother, and people will feel so much more fulfilled in their work.

Host Amber Smith: Any ideas for relaxing things that staff and students can do outside of work?

Leslie Kohman, MD: I think the most important thing is everybody has things they like to do, and it's different for everyone. The important thing is to do them. If you like to play tennis, if you like to swim, if you just like to play with your kids, if you like to go camping, whatever it is, read a book, it doesn't matter. It's what you enjoy. But to do it.

And don't say, "Well, I really love X, but I haven't done it for the last months or years." To do it, to be with the people who fulfill you, your loved ones, your friends, and to give work a break when you're not there. Turn off your device when you don't have any clinical responsibilities, and just focus on something else. You will come back refreshed and able to give patients a much better self after any experience like that.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Kohman.

Leslie Kohman, MD: Thank you. I hope that people will get the message of self-compassion. It's important for all of us.

Host Amber Smith: My guest has been Dr. Leslie Kohman. She's Upstate's chief wellness officer. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Palma Shaw from Upstate Medical University. How can someone with diabetes protect their feet?

Palma Shaw, MD: Well, it's very important that patients with diabetes are informed about the potential changes that can occur in their feet. They may develop numbness in the foot and not understand that they actually can't feel if they step on something sharp.

So we usually advise diabetic patients to use shoes in the house. They really should never walk around with bare feet in the home. We've had patients come in with a nail in their foot that they couldn't even feel that can cause an infection. They also get dry skin, so they need to cream their feet, and they really should get evaluated by a podiatrist to look for deformities of their foot to see if they need special inserts for their shoes.

Host Amber Smith: You've been listening to vascular surgeon Dr. Palma Shaw from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Johanna DeMay grew up in Mexico City. After 40 years working as a studio potter, she now writes and volunteers with the immigrant community. Her poem "Remission" reminds us of the delicate dance people in remission must perform along with those who love them.

"Remission"

My son's in remission.

He's healthy now -- no more chemo,

radiation. No blood tests, urine tests,

CAT scans, ultrasounds.

He's in remission.

He's on solid ground.

Remission's a dormant volcano.

Lately, he's felt short of breath

-- scars on his heart, his lungs.

Average lifespan of long-term survivors?

Ten years less. Volcanoes provide

no solid ground.

Free-climbers scaling a vertical wall,

patients and families cling

to nubbins of crumbly rock,

find toeholds on inch-wide ledges,

face forward, don't look down.

Even atheists bargain with God.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," a medication for sleep apnea.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

This is your host, Amber Smith, thanking you for listening.